NATHANAEL DAVID BENASSI DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****82

License Status

NOT RENEWED

Business

Title

DDS

First Name

NATHANAEL

Middle

DAVID

Last Name

BENASSI

Business Name

NATHANAEL DAVID BENASSI DDS

Original Issue Date

07/24/2013

Effective Date

10/13/2015

Expiration Date

09/30/2018

City

WINNEBAGO

State

Zip

61088

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018